High Calcium Score Research Articles

Impact of coronary artery calcium testing on patient management

BackgroundCoronary artery calcium (CAC) scoring can identify individuals who may benefit from aggressive prevention therapies. However, there is a paucity of contemporary data on the impact of CAC testing on patient management. MethodsRetrospective cohort study of adults who underwent CAC testing at Brigham and Women's Hospital between 2015 and 2019. Information on baseline medications, follow-up medications, lifestyle modification, and downstream cardiovascular testing within one-year post-CAC were obtained from electronic health records. ResultsOf the 839 patients with available baseline and follow-up data, 376 (45%) had a CAC ​= ​0, 289 (34%) had CAC ​= ​1–99, and 174 (21%) had CAC≥100. The mean age at time of CAC testing was 59 ​± ​9.7 years. Patients with higher CAC scores were more likely to be male, have diabetes and hypertension, and have higher low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol. A non-zero CAC score was associated with initiation of aspirin (41% increase, p ​< ​0.001), anti-hypertensives (9% increase, p ​= ​0.031), and lipid-lowering therapies (114% increase, p ​< ​0.001), whereas CAC ​= ​0 was not. Among individuals with CAC≥100, 75% were started on new or more intense lipid-lowering therapy. Higher calcium scores correlated with increased physician recommendations for diet (p ​= ​0.008) and exercise (p ​= ​0.004). The proportion of cardiovascular downstream testing following CAC was 9.1%, and the majority of patients who underwent additional testing post-CAC had CAC scores ≥100. ConclusionApproximately half of individuals referred for CAC testing had evidence of calcified coronary plaque, and of those who had significant calcifications (CAC≥100), nearly 90% were prescribed lipid-lowering therapies post-CAC. Rates of downstream non-invasive testing were low and such testing was mostly performed in patients who had at least moderate CAC.

Predictive Model for High Coronary Artery Calcium Score in Young Patients with Non-Dialysis Chronic Kidney Disease.

Cardiovascular disease is a major complication of chronic kidney disease. The coronary artery calcium (CAC) score is a surrogate marker for the risk of coronary artery disease. The purpose of this study is to predict outcomes for non-dialysis chronic kidney disease patients under the age of 60 with high CAC scores using machine learning techniques. We developed the predictive models with a chronic kidney disease representative cohort, the Korean Cohort Study for Outcomes in Patients with Chronic Kidney Disease (KNOW-CKD). We divided the cohort into a training dataset (70%) and a validation dataset (30%). The test dataset incorporated an external dataset of patients that were not included in the KNOW-CKD cohort. Support vector machine, random forest, XGboost, logistic regression, and multi-perceptron neural network models were used in the predictive models. We evaluated the model’s performance using the area under the receiver operating characteristic (AUROC) curve. Shapley additive explanation values were applied to select the important features. The random forest model showed the best predictive performance (AUROC 0.87) and there was a statistically significant difference between the traditional logistic regression model and the test dataset. This study will help identify patients at high risk of cardiovascular complications in young chronic kidney disease and establish individualized treatment strategies.

Rates of Ischemia Amongst Asymptomatic Patients with High Coronary Artery Calcium Scores

CACS may be used to recommend lifestyle changes or other treatment recommendations to reduce the risk of heart disease. The incidence of asymptomatic ischemia in patients with elevated CACS is poorly defined. Furthermore, the CACS cut-off above which it is clinically important and cost effective to look for and diagnose ischemia is also not well defined. The purpose of this study is to better define the incidence of asymptomatic ischemia in Parkview Heart Institute (PHI) patients with elevated CACS, including an examination of demographic data that may also influence the rate of ischemia. 118 Patients who were screened for CAD, received CACS ≥ 400, and subsequently had stress testing or invasive coronary angiogram within 6 months were admitted into the study. Through statistical analysis it was determined there was no statistical difference in rates of ischemia between patients with CACS of 400-999 and those &gt;1000. However, due to a small sample size this study will be continued to strengthen its results and investigate if demographics play a role in rates of ischemia.

High Mitral Annulus Calcium Score in Pre-Operative Chest Computerized Tomography and Adverse Outcomes in Mitral Valve Surgery.

BackgroundSevere mitral annulus calcification (MAC) is believed to bear high operative and post-operative risk during mitral valve replacement (MVR) surgery, including longer surgery time, post-surgical valvular leaks and increased rate of embolic phenomena. We hypothesized that quantification of mitral calcium in pre-operative chest computerized tomography (CCT), performed to assess aortic root before cross-clamping may help in risk assessment of adverse intraoperative and postoperative outcomes in patients undergoing MVR.MethodsWe included patients who underwent MVR between the years 2015 and 2018 at Poriya medical center. Preoperative CCT was performed using Philips iCT 256 and Agatston mitral annulus calcium score (MACS) was retrospectively calculated using Philips Intellispace portal version 8.0. Patients were divided into MACS quintiles; 1–3 quintiles were grouped (Low MACS) and compared to the 4–5 quintiles (High MACS) group for demographic, clinical operative and post-operative parameters.ResultsA total of 66 patients had MVR, out of which 61% were males, with mean age of 64±9. Concomitant coronary or valvular procedures were done in 60% of patients. The median MACS was 43. High MACS (≥854) was not associated with longer bypass or cross clamp times. No differences in the MVR results were found between the groups. There were 6 post-operative embolic events; 1 mesenteric and 5 cerebral, which were not associated with MACS.ConclusionMACS did not seem to be related to adverse outcomes in MVR. Due to a low event rate and probable pre-selection of patients without extreme mitral annulus calcifications our results should be confirmed in larger prospective study.

Angina Pektoris Hastalarında B-Tipi Natriüretik Peptit ve Kalsiyum Skoru

Objective: The purpose of this study is to look into the relationship between coronary artery disease evaluated with multislice computed tomography (MSCT) findings and B-type natriuretic peptide (BNP) and calcium score (CaS). Material and Method: The study included 83 patients who were administered to our center and who had asymptomatic and stable angina pectoris. Blood samples were collected for BNP testing, and the Abbott AxSYM System kit was used for measurements. Calcium scoring was performed on each of the four main coronary arteries, and the total “Agatston” score was calculated for each patient by summing up the results. MSCT angiograms were studied at the three-dimensional operating base. Results: Coronary artery disease (CAD) was found in 51 (61.4%) patients, while the coronary arteries of 32 (38.6%) patients were deemed normal. Single-vessel involvement was detected in 17 (20.5%) patients, two-vessel involvement in 18 (21.7%) patients, and three-vessel involvement in 16 (19.3%) patients. While patients with CAD had a median BNP of 33.9 (0–834), those without CAD had a median of 19.2 (0–185), which was statistically significant (p=0.011). Furthermore, there was a positive correlation between the number of vessels involved and BNP (r = 0.364, p=0.001). BNP levels were found to be significantly higher in hypertensive patients (p=0.008). The CaS and BNP median of the group with three-vessel involvement were significantly higher (p &amp;lt; 0.001 and p=0.007, respectively). Conclusion: As a result, high CaS and BNP levels were discovered to be a marker for the presence and severity of CAD.

Abstract 13252: Is There a Gender-Specific Association Between High Coronary Artery Calcium Score and High Polygenic CAD Risk Score?

Introduction: Genetic predisposition for CAD is well established. Polygenic risk scores are emerging as tools which attempt to quantify the genomic component of an individual’s risk for CAD. However, their clinical utility for individual risk stratification is unclear. Hypothesis: 180 SNPs previously identified in Caucasian Genome Wide-Association Studies for CAD were used to construct a weighted restricted polygenic risk score (PRS; normalized range 11.18 -17.58). This study hypothesizes a gender-specific association between high PRS (&gt;=85th percentile) and high coronary artery calcium score (CAC) score, defined as &gt;400. Methods: Between January 2018 &amp; March 2020, 21,784 patients underwent CAC screening and/or PRS testing. Caucasian patients with both PRS and CAC scores were identified. Fisher’s exact test was utilized to test the association between high PRS and high CAC in men and women. Results: Both PRS and CAC were available for 3,197 Caucasian patients, out of which 2,106 (65.8%) were women (figure 1: gender adjusted PRS distribution). Odds ratio of high PRS and high CAC was 1.64 (95% CI: 0.86-2.97; p &gt;0.05) in women and 1.59 (95% CI: 0.98 - 2.53; p&gt;0.05) in men. Conclusions: There is no statistically significant, gender-specific association between high PRS and high CAC in our Caucasian cohort. However, there is a trend suggestive of a positive correlation in women. This clinical data is the first of its kind in a real world setting on the use of PRS for CAD risk assessment. Larger, ethnically diverse studies are needed.

Abstract 12277: Concordance of High Polygenic CAD Risk Score With High Coronary Artery Calcium Score &amp; Low Polygenic CAD Risk Score With Low Coronary Artery Calcium Score: A Real World Experience

Introduction: Genetic predisposition for CAD is well established. Polygenic risk scores are emerging as tools which attempt to quantify the genomic component of an individual’s risk for CAD. However, clinical utility for individual risk stratification is unclear. Hypothesis: 180 SNPs previously identified in Caucasian Genome Wide-Association Studies for CAD were used to construct a weighted restricted polygenic risk score (PRS; normalized range 11.18 -17.58). This study hypothesizes that high PRS (&gt;=85th percentile) is associated with high (&gt;400) coronary artery calcium (CAC) score, &amp; a low PRS(&lt; 85th percentile) is associated with low (&lt;100) CAC. Methods: Between January 2018 and March 2020, 21,784 patients underwent CAC screening and/or PRS testing. Caucasian patients with both PRS and CAC scores were reviewed. Patients with CAC 100-400 were excluded. Fisher’s exact test for high/low PRS and high/low CAC was utilized. Results: 2,752 patients were identified to have low (&lt;100) or high (&gt;400) CAC; 306 (11.1%) had a high CAC (table 1). Odds ratio of high PRS associated with high CAC and low PRS associated with low CAC was 1.54 (95% CI: 1.07-2.19; p=0.017). Conclusion: Our real-world experience in a Caucasian cohort shows that high PRS is associated with a high CAC, as is a low PRS with low CAC. Concordance between PRS and CAC lends support for incorporating PRS in the clinical setting, especially for early identification of individuals at high risk for CAD. Larger, ethnically diverse studies are needed.

Abstract 13105: Coronary CT Angiography Predicts Major Adverse Events in Dialysis Dependent End-Stage Renal Disease Patients

Introduction: Coronary atherosclerosis is prevalent in the end-stage renal disease population. Cardiovascular complications are the primary cause of morbidity and mortality in this group due to advanced CAD. Coronary CT angiography (CTA) in this population is challenging due to their severe coronary atherosclerosis, often with dense calcifications that limit diagnostic specificity and sensitivity. We characterized the CAD-RADS Classification of 62 ESRD patients on chronic dialysis to assess whether CAD-RADS stratification correlates the severity of disease to major adverse cardiac events. Methods: 62 patients (mean 69 years; range 41-95 years; 59% male) underwent coronary CTA. All patients were on dialysis (83% HD, 10% PD, 7% transition between PD-HD). Average creatinine was 3.9 mg/dL. 38% of patients had history of revascularization either via CABG or PCI. CAD-RADS, coronary artery calcium score (CAC), and other parameters (diabetes mellitus, creatinine, LVEF) were investigated as predictors of cardiac events. Results: Of the 62 patients in this study, 42 patients had significant CAD (CAD-RADS 3 or greater). Average CAC score was 1999.8 Agatston Units (AU). 46 patients (74%) had interpretable CT angiograms. Higher CAC-score moderately correlated with higher CAD-RADS in patients with CAD (R = 0.58, 95% CI, 0.38-0.73, p&lt;0.0001). Analysis revealed that higher CAD-RADS score (&gt;4) is a significant predictor for the presence of major adverse cardiac events (ACS Odds-Ratio 4.03, 95% CI, 1.33-10.68, 61.7% vs 28.5%, p&lt;0.012). In addition, patients with CAD-RADS 4 or greater (including N-scores due to severe calcification), also trended towards higher mortality (Mortality Odds-Ratio 2.0, 95% CI, 0.70-5.57, 52.9% vs 35.7%, p&lt;0.20). Higher CAD-RADS, especially scores &gt;4, had higher incidence of heart failure and decreased cardiac function (LVEF 60.5% vs 47.2%, p&lt;0.003). Conclusions: CAD-RADS classification can be determined in a significant portion of ESRD patients on dialysis, even in the setting of high CAC scores. Higher CAD-RADS scores demonstrated increased incidence of major adverse cardiac events, including heart failure and ACS. This study suggests that cardiac CTA in Dialysis-Dependent-ESRD patients is feasible and prognostic.

Abstract 14381: High Coronary Artery Calcium Score Predicts Earlier and More Frequent Need for Cardiac Revascularization - A Large Scale, Single Center Study

Introduction: Coronary artery calcium score (CAC) predicts the risk of cardiac events with need of revascularization. CAC scores indicate plaque burden and are classified as low (&lt;100), moderate (100-399) or high (≥400). Hypothesis: High CAC score predicts earlier and more frequent need for cardiac revascularization (CABG or PCI) compared to low CAC score. Methods: A total of 60,719 subjects were screened for CAC score from which 1,861 underwent subsequent coronary revascularization if clinically indicated. Patients with moderately elevated CAC scores were excluded from the analysis. The incidence and timing of revascularization was compared between the low and high CAC score groups using two sample Z test. Wilcoxon rank sum test was used to calculate medians. Results: The analysis included 47 937 patients in the low CAC score group (mean age of 53.6 ± 9.9 with 59.5% female) and 5415 in the high CAC score group (mean age of 64.8 ± 8.4 with 28.2% female). As shown in Table 1, the incidence of cardiac revascularization was significantly higher in the high CAC score group (p &lt; .0001). Average time to intervention was significantly shorter in the high CAC score group (p &lt; .0001). Conclusions: Significantly higher rates of cardiac revascularization were observed in patients with high CAC score. In these individuals, the average time to revascularization was found to be lower than in the low CAC group. Low CAC score individuals had nearly double the time to an event, which is a finding with potentially high clinical significance.

Coronary arteries and aortic valve calcifications in COVID-19: Not only lungs at chest CT

Objectives: Cardiovascular diseases cause worse outcomes in patients affected by COVID-19. High coronary artery calcium score (CACS) and aortic valve calcifications (AC) increase cardiovascular risk. Our purpose is to evaluate CACS, measured by Weston Score (WS), and presence of AC in chest CT of COVID-19 patients and possibly to investigate their prognostic role. Material and methods: This retrospective case-control study includes 150 hospitalized COVID-19 patients who underwent a chest CT at admission. The case group (Group A) was formed by 50 in-patients in Intensive Care Unit (ICU) under invasive ventilation (IV), while the matching control group for sex, age and BMI (Group B) was formed by 100 in-patients in non-ICU units, not under IV. After, a second case-control selection was originated from these two Groups: the case group (Group A1) composed by 30 patients selected from Group A, and the matching control group for age, sex, BMI and CT lung severity score (LSS) (Group B1) composed by 60 patients selected from Group B. WS and the presence of AC were compared between Groups A and B, and between Groups A1 and B1. Moreover, LSS and WS were correlated. Parametric tests were used for statistical analysis. Material and methods: This retrospective case-control study includes 150 hospitalized COVID-19 patients who underwent a chest CT at admission. The case group (Group A) was formed by 50 in-patients in Intensive Care Unit (ICU) under invasive ventilation (IV), while the matching control group for sex, age and BMI (Group B) was formed by 100 in-patients in non-ICU units, not under IV. After, a second case-control selection was originated from these two Groups: the case group (Group A1) composed by 30 patients selected from Group A, and the matching control group for age, sex, BMI and CT lung severity score (LSS) (Group B1) composed by 60 patients selected from Group B. WS and the presence of AC were compared between Groups A and B, and between Groups A1 and B1. Moreover, LSS and WS were correlated. Parametric tests were used for statistical analysis. Results: Among the 150 patients, 105 (70.0%) were male and 45 (30.0%) female. The age was 70.2 ± 13.3 years. LSS was 7.5 ± 3.9, WS was 6.4 ± 3.0; AC was present in 97/150 (64.7%). WS was significantly higher in Group A than in Group B, respectively, 7.4 ± 4.0 and 5.7 ± 2.6 (p=0.0146), and also the presence of AC, respectively, 41/50 (82.0%) vs 56/100 (56.0%) (p=0.0016). In Group B, LSS and WS had a linear positive correlation (r=0.2240, p=0.0405). Finally, WS and AC were significantly higher in Group A1 compared to Group B1. Conclusions: Both WS and AC were higher in ICU COVID-19 patients than in non-ICU COVID-19 patients: they could have a predictive role in the pejorative evolution of the disease.

Determinants of high-risk coronary artery disease in ostensibly healthy male master endurance athletes

Abstract Background Healthy male master endurance athletes have a greater prevalence of high coronary calcium (CAC) scores compared to healthy sedentary counterparts, and some demonstrate high-risk plaque features. A number of theories have been postulated but reasons remain unclear. Concurrently atherosclerotic coronary artery disease (CAD) is the most common cause of sudden cardiac death in male master athletes drawing much public and scientific interest and making this an important public health issue. Purpose To examine the relationship of age, resting systolic blood pressure (SBP), exercise dose and sporting discipline with high-risk CAD markers in male master endurance athletes. Methods A prospective study undertaken over 19 months evaluated 214 male master (40–65 years) endurance athletes, free from known cardiovascular risk factors, symptoms or relevant health conditions. Clinical evaluation included cardiopulmonary exercise test, resting blood pressure (BP) and coronary computed tomogram angiography (CCTA). CCTA assessed CAC score, significant stenosis, (&amp;gt;50%) and plaque vulnerability markers. Exercise dose was defined by years of endurance exercise and average MET-hours/week (lifetime exercise volume multiplied by the metabolic equivalent scores). Resting BP was the average of 3 consecutive supine measures after at least 5 minutes rest. Results Athletes (mean age 51, SD 70.1) exercised for minimum 6 hours/week (median 8.5) for a median of 15 years (2–26). Almost half (60.2%) were multi-endurance athletes i.e. any combination swimming, cycling and running. The remainder were runners (22.4%) and cyclists (15.4%). Median Framingham risk score 3.2% (1.8–5.8). The mean resting BP was 129/80 mmHg and a quarter (26%) of athletes were hypertensive (≥140/90 mmHg) at rest. A CAC score &amp;gt;100 Agatston units (AU) was present in 16% of athletes. There was a total of 15 stenotic lesions in 11 (5%) athletes. 13% had plaque vulnerability markers. Logistic regression evaluated whether age, resting SBP, exercise dose measures and sporting discipline were predictive for a CAC score &amp;gt;100 AU, significant stenosis and plaque vulnerability markers (table 1). CAC score was associated with age, years of endurance exercise and resting SBP. A Stenosis &amp;gt;50% and plaque vulnerability markers were associated with resting SBP and cycling compared with all other sporting disciplines. Conclusion Despite correcting for age, higher exercise dose (years endurance exercise) is associated with CAC score &amp;gt;100 AU but does not predict significant stenosis or plaque vulnerability markers. Resting SBP and cycling strongly predict high-risk disease. Cycling enables a greater intensity of exercise compared with other endurance sports, which may be associated with prolonged rises in SBP. Resting SBP and cycling are important determinants for high-risk CAD in middle-aged male endurance athletes and should be considered when risk stratifying in pre-participation evaluation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship

Is there a different impact of traditional risk factors on calcium score, in an asymptomatic population?

Abstract Background The coronary calcium score has been increasingly used to stratify and predict cardiovascular risk, particularly in low and intermediate-risk persons. Understanding which determinants have more impact on coronary calcium score level, could lead to the development of new stricter preventive measures for reducing coronary artery calcification (CAC) and, consequently, cardiovascular risk. Purpose Our study aimed to investigate the impact of the traditional risk factors (TRFs) on the CAC score level and if there is a different association between this TRFs and CAC score degrees, in an asymptomatic population. Methods The study cohort comprised 1,122 consecutive asymptomatic individuals without known coronary artery disease (CAD) belonging to the healthy controls of GENEMACOR study and referred for computed tomography for CAC scoring assessment. The traditional risk factors considered were (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary artery disease. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC&amp;lt;100 and P&amp;lt;50); moderate CAC (100≤CAC&amp;lt;400 or P50–75) and high or severe CAC (CAC≥400 or P&amp;gt;75). We evaluated the association of the different TRFs with these levels of CAC score (Chi-square test). Finally, we performed a logistic regression model adjusted for all significant TRFs selected in the bivariate analyses. Results Smoking was significantly associated with high levels of CAC score, 28.4% vs 21.7%; p=0.038 as well as hypertension, 58.8% vs 45.6%; p=0.001, type 2 diabetes 21.1% vs 9.6%; p&amp;lt;0.0001, dyslipidemia, 73.0% vs 66.1%; p=0.057. Family history did not show a significant association with CAC (p=0.717). Then, we constructed a logistic regression model adjusted the significant risk factors in previous analysis. The final multivariate analysis, selected as independent predictors of high CAC: Type 2 diabetes; OR=2.309; 95% CI 1.533–3.479; p&amp;lt;0.0001, hypertension; OR=1.627; 95% CI 1.185–2.233; p=0.003, and smoking, OR=1.565; 95% CI 1.102–2.222; p=0.012. Conclusions In this study, well-known and modifiable cardiovascular risk factors are associated with high calcium score levels. However, hypertension and diabetes seem to be preferentially associated with higher CAC scores, while tobacco, although it has a significant association, seems to be not so strong as diabetes and hypertension. This concept may mean that smoking has its primary role in plaque instability and not so much in the growing and calcification of plaques. Funding Acknowledgement Type of funding sources: None.

Coronary calcification by computed tomography in patients with paroxysmal and persistent atrial fibrillation undergoing catheter ablation

Abstract Introduction Cardiac computed tomography (CCT) is routinely performed for pulmonary vein isolation (PVI) planning in patients with paroxysmal or persistent atrial fibrillation (AF). This imaging method can also identify coronary artery calcium (CAC). Purpose To evaluate the prevalence of CAC in patients with paroxysmal and persistent AF undergoing catheter ablation. Methods Cross-sectional study including patients with AF/atrial flutter (AFL) undergoing CCT for ablation procedure planning from 2017 to 2019. Baseline clinical and demographic data were collected and CAC score was assessed using the Agatston method. Patients with paroxysmal and persistent AF/AFL (defined according to 2020 European Society of Cardiology guidelines for the diagnosis and management of AF) were compared. Results A total of 474 patients were included (441 with AF and 33 with AFL), with a mean age of 57±12 years, of which 295 (62%) were males. CHA2DS2-VASc score was ≥1 (male) or ≥2 (female) in 278 (64%) patients and most patients had a low to moderate cardiovascular risk (259, 80%). CAC was identified in 254 (54%) patients. AF/AFL was paroxysmal in 348 (75%) patients and persistent in 116 (25%). Baseline characteristics and cardiovascular risk factors were similar between groups except for diabetes mellitus (33 [10%] vs 22 [20%], p=0.012) and valvular heart disease (13 [4%] vs 18 [16%], p&amp;lt;0.001) that were more prevalent in patients with persistent AF/AFL. Patients with persistent AF/AFL had higher left atrial volume and left ventricle mass (36±8 vs 43±12 ml/m2, p&amp;lt;0.001 and 90±22 vs 96±22 g/m2, p=0.041). CAC was more frequently present in patients with persistent AF/AFL (175 [50%] vs 72 [62%], p=0.028), especially CAC score &amp;gt;100 (58 [17%] vs 35 [30%], p=0.002). After multivariate analysis, CAC score&amp;gt;100 remained an independent predictor of persistent AF/AFL (OR 2.12, 95% CI 1.18–3.82, p=0.013) along with higher left atrial volume (OR 1.06, 95% CI 1.03–1.08, p&amp;lt;0.001). Conclusion In this study, coronary artery calcium was present in more than half of AF/FLA patients undergoing catheter ablation. Patients with persistent AF/AFL showed higher calcium scores and this could derive from chronic, more advanced disease. Especially in those patients, opportunistic CV risk screening and CAC-guided clinical management might be clinically useful. Funding Acknowledgement Type of funding sources: None.

Epigenetic changes in carotid plaques with high calcium scores; DNA methylation and microrna assessments

Epigenetic changes in carotid plaques with high calcium scores; DNA methylation and microrna assessments

What Has Dual Energy CT Taught Us About Gout?

Dual energy computed tomography (DECT) scan has emerged as a useful diagnostic tool in the diagnosis of gout over recent years. Here, we review the role of DECT in the context of typical and atypical gout, including its role in identifying extra-articular monosodium urate (MSU) deposition. DECT has been found to be more accurate than ultrasound in detecting extra-articular MSU deposition in soft tissue. It has the ability to identify axial MSU deposition in gout patients with non-specific back pain. For individuals with no other clear etiology, this potentially implicates MSU as the cause of the pain. DECT also has the ability to detect vascular MSU deposition. This correlates with high coronary calcium scores and elevated Framingham cardiovascular risk. DECT continues to aid our understanding of articular and extra-articular MSU deposition, including the role of vascular MSU deposition on cardiovascular health. Not only does it allow quantification of urate burden but it can also potentially avoid invasive diagnostic procedures. The limitations and advantages of DECT are further explored in this article.

Evaluating Health Risks in People with Very High Coronary Artery Calcium Scores

Increasingly, studies are validating the prognostic importance of coronary artery calcium (CAC). An open question is the implication of very high CAC

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting.

Background In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. Methods A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. Results Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). Conclusion Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Medium-term prognostic value of angio-TC in type 2 diabetic patients without known cardiopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introdution The use of coronary angiography by cardiac CT for the active search for coronary disease in asymptomatic diabetic patients is not generally indicated. On the other hand, in the case of high-risk patients with a high calcium score, there are results that do show a potential benefit of expanding the study with CT coronary angiography. Purpose The aim was to determine the medium-term prognostic value of computed tomography non-invasive coronary angiography (CT angiography) to predict major cardiac events in type 2 diabetic patients (p) without previous cardiac symptoms Methods Observational and prospective study in diabetic patients without symptoms suggestive of coronary heart disease (CHD), derived from performing a CT in the previous 5 years, for different reasons, not related to acute coronary syndrome. The presence of CHD was analyzed, as well as the incidence for cardiac events during follow-up. Results 402 diabetic patients, mean evolution time of the disease: 6.8 +/- 2.1 years, mean Hb1Ac 8.1 +/- 0.7%. 60% of patients were male. Regarding other cardiovascular risk factors: 66.3% were hypertensive. 58.8% dyslipidemic. 26.3% obese. 27.5% smokers. 32.5% ex-smokers. 36.3% had a family history of CHD. Most frequent indication for CT: CHD screening, with previous inconclusive tests (26.3%), followed by pre-surgery evaluation (25%). Agatston Score 278.3 ± 235.8, Agatston Score&amp;gt; 400 132 (32.8%), significant CHD 174 (43.2%), Vulnerable plaques 84 (20.9%) The average follow-up was 5 years (+/- 1.3); 90 p (22.3%) suffered cardiac events (63 cardiac deaths, 27 non-fatal myocardial infarction). Best correlation with events was observed with the presence of significant coronary disease (ostruction&amp;gt; 50%) compared to the Agatston score and the presence of vulnerable plaques (adjusted c-index of 0.59 versus univariate c-index of 0.42, respectively) The annual event rate for patients with normal coronary arteries was 1.8%, which translated into a 5-year event-free survival period. The highest annual event rate of 22.3% was detected in patients with obstructive 3-vessel CAD Conclusions Non-invasive CT angiography allows, after quantifying plaque severity in diabetic patients, to reclassify patients at high / very high risk Diabetic patients with normal coronary arteries on CT angiography had a 5-year survival period free of major cardiac events.

Association of Global Cardiac Calcification with Atrial Fibrillation and Recurrent Stroke in Patients with Embolic Stroke of Undetermined Source

Calcium deposits in the heart have been associated with cardiovascular events, mortality, stroke, and atrial fibrillation (AF). However, there is no accepted standard method for scoring cardiac calcifications. Existing methods have also not been validated for the assessment of patients with embolic stroke of undetermined source (ESUS). The aim of this study was to evaluate the association of various cardiac calcification scores with new-onset AF and stroke recurrence in a cohort of patients with ESUS. In this study, 181 consecutive patients with stroke diagnosed with ESUS were identified and evaluated. They were followed for new-onset AF and ischemic stroke recurrence for a median duration of 2.1years. Various echocardiographic cardiac calcification scores were assessed on transthoracic echocardiography performed during the evaluation of ESUS and subsequently assessed for their relation to AF detection and recurrent stroke. The echocardiographic calcium scores assessed were the (1) global cardiac calcium score (GCCS), (2) echocardiographic calcium score (eCS), (3) echocardiographic calcification score, (4) echocardiographic composite cardiac calcium score, and (5) total heart calcification score. Only two of these scoring schemes, GCCS and eCS, quantified the cardiac calcium burden. Higher calcium scores as measured by GCCS and eCS were found to be significantly associated with subsequent AF detection as well as recurrent ischemic stroke in patients with ESUS. The association with recurrent stroke remained significant even after adjustment for comorbidities and AF. Higher cardiac calcification measured using the GCCS and eCS is independently associated with AF detection and recurrent ischemic stroke in patients with ESUS, and these scores can be useful markers for further risk stratification in patients with ESUS.

Alcohol-related cirrhosis is associated with high coronary artery calcium scores in patients undergoing evaluation for orthotopic liver transplantation.

Coronary artery disease is a major cause of morbidity and mortality in liver transplant patients. Coronary artery calcium (CAC) score has been used to evaluate the risk of CAD in non-cirrhotic patients. However, its significance in cirrhotic patients is unknown. This study aimed to identify factors associated with elevated CAC scores in patients with end-stage liver disease undergoing liver transplant evaluation. We retrospectively reviewed all patients who underwent liver transplantation evaluation and had coronary CT scan between January 2015 and December 2018. Patients with prior history of CAD were excluded. CAC score was calculated based on the method described by Agatston. Sixty-two patients were included. 37.1% had alcohol-related liver disease and 27.4% had NASH cirrhosis. Mean CAC score was 261.1±SD, 463.84. Alcohol-related liver disease, male gender, and hypertension were significantly associated with CAC score >100 and only alcohol-related liver disease was associated with CAC score >300. In logistic regression, patients with alcohol-related liver disease had more than sixfold increase in risk of having CAC scores >100 and 300 (OR 6.14, and 6.70, respectively). Alcohol-related liver disease, male gender, and hypertension were significantly associated with an increased CAC score >100. However, alcohol-related liver disease was the only factor associated with CAC score >300.